Identify the Corporation:

Name:

Street Address:

City, State ZIP:

What is the corporate structure :

S Corporation (cash or accrual)

Partnership

C Corporation (cash or accrual)

Limited Liability Company (LLC)

When a Shareholder dies:

their Shares will be purchased AND life insurance to pay for the Shares is to be maintained

their Shares will be purchased (but no insurance is required)

PSA In The Media

When a Shareholder becomes totally disabled:

their Shares will be purchased AND disability insurance to pay for the Shares is to be maintained

their Shares will be purchased (but no insurance is required)

Agreement is to be silent

When a Shareholder leaves before retirement:

their Shares will be purchased at fair market value

their Shares will be purchased at a discount to fair market value of

When is normal retirement Age :

Age 60

Age 65

Other

Are Shareholders covenant not to compete with the Corporation after cessation of employment:

Yes

No

For how many years :

Area or restriction :

If Shares are to be purchased, purchaser may pay in installments evidenced by a Note:

Yes

No

How many monthly installments?

Rate of interest:

% or

Fed. Rate or other

Are family members Shareholders in business:

Yes

No

Can Shareholders transfer Shares to family members without "triggering"
the right of first refusal which is otherwise applicable to voluntary transfers

Yes

No

The purchase price of each Share is to be based on:

fair value based on the assets and liabilities of the Corporation

formal valuation

Other (explain formula)

The present value of each Share:

The future value of each Share to be stipulated:

by valuation

by percentage increase

by formula

The future value of each Share to be reviewed:

annually

bi-annually

every three years

Information for Shareholder #1

Name:

Street Address:

City, State ZIP:

Telephone #:

Information for Shareholder #2

Name:

Street Address:

City, State ZIP:

Telephone #:

Information for Shareholder #3

Name:

Street Address:

City, State ZIP:

Telephone #:

Information for Shareholder #4

Name:

Street Address:

City, State ZIP:

Telephone #:

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